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Routine Drain Placement in Roux-en-Y Gastric Bypass: An Expanded Retrospective Comparative Study of 755 Patients and Review of the Literature

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Abstract

Routine drain use after laparoscopic Roux-en-y gastric bypass (LRYGB) is still practiced by many bariatric surgeons. After a patient in our program experienced intestinal obstruction secondary to a drain, we reevaluated our practice and hypothesized drains would be of no benefit and potentially harmful after LRYGB. Retrospective record review of all patients undergoing LRYGB from August 2005 to August 2009 was performed. As we changed our practice in December 2006, we have two comparable groups: one with a drain placed at surgery and one without. All operations were otherwise performed in an identical fashion by three fellowship-trained university surgeons. We compared outcomes between the two groups, particularly regarding gastrojejunal (GJ) leaks. Jejunojejunal (JJ) leaks, unlikely to be captured by these drains, were not studied. A total of 755 LRYGBs were performed during the study period, the first 272 patients with routine drains and the subsequent 483 without. Demographics were statistically similar between the two groups. There were four GJ leaks in the drain group (1.47%) and three in the nondrain group (0.62%). Among the drain patients, two required operation and two were treated nonoperatively. Among the nondrain patients, two required operation and one was treated nonoperatively. The leak and reoperation rates between the groups were not statistically different (p = 0.154 and p = 0.514). Routine drains likely have no benefit after LRYGB. Clinical parameters such as tachycardia, fever, oliguria, and increasing abdominal pain should guide further investigation for and treatment of a leak.

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References

  1. Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19:1605–11.

    Article  PubMed  Google Scholar 

  2. Chousleb E, Szomstein S, Podkameni D, et al. Routine abdominal drains after laparoscopic Roux-en-Y gastric bypass: a retrospective review of 593 patients. Obes Surg. 2004;14:1203–7.

    Article  PubMed  Google Scholar 

  3. Salgado Jr W, Cunha Fde Q, dos Santos JS, et al. Routine abdominal drains after Roux-en-Y gastric bypass: a prospective evaluation of the inflammatory response. Surg Obes Relat Dis. 2010;6:648–52.

    Article  PubMed  Google Scholar 

  4. Rogers AM, Cherenfant J, Kipnis S, et al. Drain-associated intestinal obstruction after laparoscopic gastric bypass. Obes Surg. 2007;17:980–2.

    Article  PubMed  Google Scholar 

  5. Poon CM, Leong HT. Abdominal drain causing early small bowel obstruction after laparoscopic colectomy. JSLS. 2009;13:625–7.

    PubMed  Google Scholar 

  6. Ruiz-Tovar J, Rubio M, Conde S, et al. Inferior epigastric artery pseudoaneurysm: complication of surgical drain insertion. ANZ J Surg. 2008;78:1139.

    PubMed  Google Scholar 

  7. Castagnetti M, Cimador M, De Grazia E. Duodenal perforation due to an abdominal drain placed after appendectomy in a child. Pediatr Med Chir. 2008;30:99–101.

    PubMed  CAS  Google Scholar 

  8. Gurusamy KS, Samraj K, Mullerat P, et al. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2007;17:CD006004.

    Google Scholar 

  9. Kadija S, Sparic R, Zizic V, et al. Drainage as a rare cause of intestinal incarceration. Srp Arh Celok Lek. 2005;133:370–1.

    Article  PubMed  Google Scholar 

  10. Pelayo Salas A, Perez Ruiz L, Ferminan Rodriguez A, et al. Strangulated small bowel evisceration after intraperitoneal drainage. Minerva Chir. 2005;60:291–2.

    PubMed  CAS  Google Scholar 

  11. Yeh CY, Changchien CR, Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2005;241:9–13.

    PubMed  Google Scholar 

  12. Kulkarni S, Krijgsman B, Sharma D, et al. Incarcerated small bowel hernia through drain site. Ann R Coll Surg Engl. 2004;86:W24–5.

    PubMed  Google Scholar 

  13. Wang JY, Hsieh JS, Chen FM, et al. Rectal perforation secondary to surgical drains after low anterior resection: a report of two cases and review of the literature. Kaohsiung J Med Sci. 2002;18:146–8.

    PubMed  Google Scholar 

  14. Komuta K, Haraguchi M, Inoue K, et al. Herniation of the small bowel through the port site following removal of drains during laparoscopic surgery. Dig Surg. 2000;17:544–6.

    Article  PubMed  CAS  Google Scholar 

  15. Yoshida H, Onda M, Tajiri T, et al. Colonic varices ruptured via drainage catheter after extended right hepatectomy. Hepatogastroenterology. 2000;47:718–9.

    PubMed  CAS  Google Scholar 

  16. Grunewald B, Kato G. Intestinal perforation by suction drains. N Z Med J. 1997;110:19.

    PubMed  CAS  Google Scholar 

  17. Shope TR, Cooney RN, McLeod J, et al. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg. 2003;13:355–9.

    Article  PubMed  Google Scholar 

  18. Sharma S, Kim HL, Mohler JL. Routine pelvic drainage not required after open or robotic radical prostatectomy. Urology. 2007;69:330–3.

    Article  PubMed  Google Scholar 

  19. Bacha OM, Plante M, Kirschnick LS, et al. Evaluation of morbidity of suction drains after retroperitoneal lymphadenectomy in gynecological tumors: a systematic literature review. Int J Gynecol Cancer. 2009;19:202–7.

    Article  PubMed  Google Scholar 

  20. Alvarez Uslar R, Molina H, Torres O, et al. Total gastrectomy with or without abdominal drains: a prospective randomized trial. Rev Esp Enferm Dig. 2005;97:562–9.

    Article  PubMed  CAS  Google Scholar 

  21. Jesus EC, Karliczek A, Matos D, et al. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004;18:CD002100.

    Google Scholar 

  22. Kim J, Lee J, Hyung WJ, et al. Gastric cancer surgery without drains: a prospective randomized trial. J Gastrointest Surg. 2004;8:727–32.

    Article  PubMed  Google Scholar 

  23. Conlon KC, Labow D, Leung D, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2001;234:487–93.

    Article  PubMed  CAS  Google Scholar 

  24. Merad F, Hay JM, Fingerhut A, et al. Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery. 1999;125:529–35.

    Article  PubMed  CAS  Google Scholar 

  25. Fong Y, Brennan MF, Brown K, et al. Drainage is unnecessary after elective liver resection. Am J Surg. 1996;171:158–62.

    Article  PubMed  CAS  Google Scholar 

  26. Lopes AD, Hall JR, Monaghan JM. Drainage following radical hysterectomy and pelvic lymphadenectomy: dogma or need? Obstet Gynecol. 1995;86:960–3.

    Article  PubMed  CAS  Google Scholar 

  27. Manz CW, LaTendresse C, Sako Y. The detrimental effects of drains on colonic anastomoses: an experimental study. Dis Colon Rectum. 1970;13:17–25.

    Article  PubMed  CAS  Google Scholar 

  28. Garcia-Caballero M, Carbajo M, Martinez-Moreno JM, et al. Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant. Obes Surg. 2005;15:719–22.

    Article  PubMed  Google Scholar 

  29. Marshall JS, Srivastava A, Gupta SK, et al. Roux-en-Y gastric bypass leak complications. Arch Surg. 2003;138:520–3.

    Article  PubMed  Google Scholar 

  30. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235:640–5.

    Article  PubMed  Google Scholar 

  31. Madan AK, Martinez JM, Lo Menzo E, et al. Omental reinforcement for intraoperative leak repairs during laparoscopic Roux-en-Y gastric bypass. Am Surg. 2009;75:839–42.

    PubMed  Google Scholar 

  32. Alaedeen D, Madan AK, Ro CY, et al. Intraoperative endoscopy and leaks after laparoscopic Roux-en-Y gastric bypass. Am Surg. 2009;75:485–8.

    PubMed  Google Scholar 

  33. Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23:1403–8.

    Article  PubMed  Google Scholar 

  34. Nguyen NT, Longoria M, Chalifoux S, et al. Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery. Surg Technol Int. 2005;14:107–11.

    PubMed  Google Scholar 

  35. Silecchia G, Boru CE, Mouiel J, et al. Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg. 2006;16:125–31.

    Article  PubMed  CAS  Google Scholar 

  36. Nguyen NT, Nguyen CT, Stevens CM, et al. The efficacy of fibrin sealant in prevention of anastomotic leak after laparoscopic gastric bypass. J Surg Res. 2004;122:218–24.

    Article  PubMed  CAS  Google Scholar 

  37. Shikora SA, Kim JJ, Tarnoff ME. Reinforcing gastric staple-lines with bovine pericardial strips may decrease the likelihood of gastric leak after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2003;13:37–44.

    Article  PubMed  Google Scholar 

  38. Maher JW, Bakhos W, Nahmias N, et al. Drain amylase levels are an adjunct in detection of gastrojejunostomy leaks after Roux-en-Y gastric bypass. J Am Coll Surg. 2009;208:881–4.

    Article  PubMed  Google Scholar 

  39. Thodiyil PA, Yenumula P, Rogula T, et al. Selective nonoperative management of leaks after gastric bypass: lessons learned from 2675 consecutive patients. Ann Surg. 2008;248:782–92.

    Article  PubMed  Google Scholar 

  40. Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007;11:708–13.

    Article  PubMed  Google Scholar 

  41. Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204:47–55.

    Article  PubMed  Google Scholar 

  42. Dallal RM, Bailey L, Nahmias N. Back to basics—clinical diagnosis in bariatric surgery. Routine drains and upper GI series are unnecessary. Surg Endosc. 2007;21:2268–71.

    Article  PubMed  Google Scholar 

  43. ASMBS Clinical Issues Committee. ASMBS guideline on the prevention and detection of gastrointestinal leak after gastric bypass including the role of imaging and surgical exploration. Surg Obes Relat Dis. 2009;5:293–6.

    Article  Google Scholar 

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Conflict of Interest

The authors declare that they have no conflict of interest. The authors do not have a financial interest/relationship with the manufacturer of any health care-related commercial product and/or provider of commercial services discussed in this manuscript. The authors received no financial or material support for this manuscript.

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Authors and Affiliations

  1. Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, PO Box 850 MC H149, Hershey, PA, 17033, USA

    Srinivas Kavuturu, Ann M. Rogers & Randy S. Haluck

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  1. Srinivas Kavuturu
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  2. Ann M. Rogers
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  3. Randy S. Haluck
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Correspondence to Ann M. Rogers.

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Kavuturu, S., Rogers, A.M. & Haluck, R.S. Routine Drain Placement in Roux-en-Y Gastric Bypass: An Expanded Retrospective Comparative Study of 755 Patients and Review of the Literature. OBES SURG 22, 177–181 (2012). https://doi.org/10.1007/s11695-011-0560-5

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